Nearly half of Pakistani nurses show depressive symptoms, study finds

Nearly half of Pakistan’s nursing workforce shows symptoms of depression, according to a new systematic review and meta-analysis

Islamabad:  Nearly half of Pakistan’s nursing workforce shows symptoms of depression, according to a new systematic review and meta-analysis that examined 22 studies involving 3,190 nurses. The study found that 49 percent of nurses included in the research had depressive symptoms, making mental health a major concern for the nursing profession and the wider healthcare system.

The study, titled “Prevalence of depressive symptoms in the nursing workforce in Pakistan: Systematic review and meta-analytic evidence”, was conducted by Hamideh Ebrahimi, Masoud Mohammadnezhad, Mohammad Hossein Falahat Pishe and Anil Fastenau. The researchers examined published evidence on depressive symptoms among registered nurses working in clinical settings across Pakistan.

The researchers found that the overall pooled prevalence of depressive symptoms was 49 percent, with a 95 percent confidence interval ranging from 39 percent to 58 percent. However, the study also found very large differences between the studies, with statistical heterogeneity reaching 97.15 percent. The researchers said this variation was likely linked to differences in the nurses studied, healthcare settings and, especially, the tools used to measure depressive symptoms.

The results changed significantly depending on the assessment tool. Studies using the PHQ-9 questionnaire reported a prevalence of 38 percent, while those using DASS-21 reported a prevalence of 61 percent. The researchers said this difference shows why using more consistent assessment methods is important when measuring depression among nurses.

Khyber Pakhtunkhwa recorded the highest prevalence estimates among the provinces included in the research. The study examined regional differences because working conditions, healthcare facilities and other local factors may affect the mental health of nurses.

The researchers found no significant change in depressive symptom prevalence over time. Their meta-regression analysis showed no meaningful link between the year a study was published and its reported prevalence. In simple terms, the available research did not show that the problem has clearly become better or worse over the years.

The study says nursing is a demanding profession because nurses provide continuous patient care, respond to changing medical conditions and make important decisions under pressure. Heavy workloads, major professional responsibilities and regular exposure to illness, pain and suffering can place considerable psychological pressure on nurses.

The researchers also point to problems within Pakistan’s healthcare system that may add to this pressure. These include shortages of nursing staff, high patient-to-nurse ratios and limited organisational support. Previous research reviewed by the authors has also linked heavy workloads, occupational burnout and workplace stress with a higher risk of depressive symptoms among nurses.

The mental health of nurses is important not only for the nurses themselves but also for patients and hospitals. The study notes that depressive symptoms have been linked in previous research with lower motivation, chronic tiredness, reduced job satisfaction, lower work engagement, increased absence from work and a greater chance of leaving the nursing profession. These problems can add to shortages of nurses.

The researchers also warn that psychological problems among nurses can affect their work and interactions with patients. Previous studies have reported possible links between depression and psychological distress and lower work performance, problems in nurse-patient interaction and poorer patient-related outcomes. Research in Pakistan has also reported medication administration errors and workplace stress among nurses.

The study is the first comprehensive systematic review and meta-analysis, according to the authors, to bring together available research on depressive symptoms among nurses in Pakistan and examine differences by region, time and assessment tool. Earlier studies had looked at individual hospitals or groups of nurses, but their findings had not previously been combined in a single national-level analysis.

For the review, the researchers searched PubMed, Embase, Scopus, Web of Science, PsycINFO and Pakistan-based databases. The work followed international PRISMA guidelines, while two reviewers independently carried out data extraction and quality assessment using the Joanna Briggs Institute checklist. A random effects model was then used to calculate the combined prevalence.

The study compares the 49 percent prevalence among Pakistani nurses with a reported 33.03 percent prevalence among healthcare workers in the Eastern Mediterranean Region. It also compares the result with a reported 37 percent prevalence among nursing students in Pakistan. The researchers say the higher level among working nurses may reflect the greater professional responsibilities and pressures faced after entering the workforce.

The researchers caution that the 49 percent figure should not be read as meaning that 49 percent of Pakistani nurses have a formal clinical diagnosis of depression. The study measures depressive symptoms reported through different assessment tools across published studies, and the large differences between those tools are one reason the authors call for more standardised measurement.

The analysis also found no strong evidence of publication bias despite some indication of asymmetry in one statistical test. Egger’s test suggested possible funnel plot asymmetry, but a Trim and Fill analysis did not show substantial publication bias.

The authors say working conditions need attention if the mental health burden among nurses is to be reduced. They call for stronger organisational support and improvements in workplaces rather than relying only on individual nurses to manage psychological pressure.